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86
An undoubted cause of the spread of phthisis in this Borough (especially among
children, who play in the streets for many hours) is the fact that persons are allowed
to misuse the streets, and among other uncleanly habits, to expectorate freely. If
anything could be done to remedy this (e.g.—the frequent cleansing of all the streets
with water), it would certainly tend to check the spread of infection from phthisis
and other diseases.
Sanatorium awl open-air treatment.
Sanatorium treatment is difficult to procure and the problems both of providing
and accepting it are complicated by the fact that, if the wage-earner goes away the
rest of the family must be supported ; there is also the difficulty and expense of
finding someone to look after the children if the mother has to go. Yet, various
societies do assist admirably in sending phthisical patients away for open-air
or for educational treatment ; but as far as I am aware, there are unfortunately
no facilities for providing any special accommodation, such as " open-air
shelters " for patients in their own home. Favourable results are said to have
followed the use of such shelters in other parts of London ; it seems likely that in
this Borough also, they would be of ereat service, both to those who return from
sanatoria, and those who remain at home.
The good effects of sanatorium and educational treatment are often very much
lessened when the patient returns home, perhaps to share a sieeping room or to sleep
in the living-room. The provision of shelters would tend to maintain the improve
ment gained in the sanatorium ; it might also encourage the provision of sanatorium
treatment, for at present charitable societies sometimes refuse to arrange this for an
otherwise eligible patient, because the conditions to which he must return are so
unfavourable that it would be useless to send him away. In the case of those who,
for various reasons, must remain at home, the use of such shelters would reduce
the risk of the patient infecting other members of his family, and might also
assist to keep him in better health, and so to remain longer at work.
It must be admitted that this branch of the work is often very discouraging,
especially when one sees a patient becoming worse for the want of special nourishment,
a light, airy home, change of air, and other such necessary aids to health.
But sometimes one has the satisfaction of seeing progress made ; this generally
occurs when the patient's illness is detected at an early stage and promptly treated,
or, when a patient is suspected of having phthisis and is treated as though a definite
diagnosis had been made. In these cases charitable agencies are often willing to
assist (as by providing sanatorium treatment), and do so very thoroughly ; the